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HomeMy WebLinkAboutSWG2024-00107 - SWG As-Built - 6/11/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY 11C HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG C`Zy - pt)IU-1 Parcel# ].T 90C 'b Applicant Name iWce LG Subdivision (Name/Div/Block/Lot) Applicant Address u15 f IZkoexywU City. State, Zip lfi. 6 `yet Ii 1A`� CkSU In Installer Name t-} j`w /°al I Site Address CG I...,�. Designer Name tUaln ifiVl�rr INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only ❑ Drainfield Only Repair ❑Other System Type - X(�,` Pretreatment Type >5 ft.from foundation? - - - - - - - - - - -- - - - - - - ❑ NIA SYES ❑ NO >50ft. from wells? - - - - - - --- - Qa�B -�f }�I _ ❑ ® ❑ 66 tJ I}ttltl jl'II}tt7l� III ❑ ® ❑ Z >50 ft.from surface water? - - - - - - - i Cleanout between building and tank? - dll 9 -���4 - ❑ �.], ❑ L) Tank baffles present? - - - - - - - - - - 11 - -- - - - - - - - - - ❑ ®' ❑ d24'access risers over each compartmen1?BY - - - - - ❑ �] ❑ nl Effluent filter installed?- - - - -- - - -- - - - - - - - - - ❑ ❑ N Septic tank capacity(working) I SC C, gal Manufacturer li 0 D-box water level and speed levelers used? - - - - - - - - - - -- - - - [TNIA ❑ YES ❑ No �O Manifold/D-box accessible from surface?- - - - - - - - - - ❑ ❑ ❑ °PZ Check valves installed? - - - - - - - - - - - - -- -- ❑ ® ❑ M Transport Line Size I Schedule/Class y 0, Bedrooms installed (check one) ❑ 2 0�3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft. from foundation? - - - - - - - - - - - - - - - - - - - - - —-- -- ❑ NIA EaYES ❑ NO 0 >100 ft.from wells?- - - - - - - - - - - - -- - - - - - -- -- - - - - -- ❑ 9 ❑ W >100 ft. from surface water? - -- - -- - - - - - - - - - - - - - --- - - ❑ '©' ❑ a >10ft, from potable water lines?- - -- - - - - - - - - - - - - - - - - - - ❑ ® ❑ Z > 5ft. from property lines and easements?- - - - - - -- - - - - - - -- ❑ ❑ It > 30 ft.from downgradient curtain/foundation drains? - - - - - - - - - - ❑ ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ [� ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - -- - - - - - -- - - --- - -- ❑ ® ❑ Pump tank setbacks consistentwith septic tank? - - --- - -- -- - - - NIA ® Yes NO Y Pump tank capacity(flood) 1250 at Manufacturer IBIS x r i .1� Z 24"access risers)and accessible from surface? - - - - - - - - - - - ❑ ❑ FQ El or Control Panel Installed? - - - - -- - - - - - - - - - - ' - -- - ❑ C ID ® ❑ 2 Control Panel equipped with Timer/ ETM/Counter- - - - - - - - -- - D d Pump installed in ❑ Bucket or [�j On Block or ❑ Other rraa o- Pump MakerModel Atb Roals or ❑ Transducer 5C' a Tank draw down C;C r in/min Pump capacity gpm Squirt Height_NA ft Pump on time a-. Pump off time OJCnh Daily flow set at 3l(- gpd uxasv e ra^�e Mason County OSS Installation Report pg. 2 Parcel# 2'Wik,- C' ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - - - - - -CRI YES NO If yes, please describe'. Were all components pumped out and properly abandoned per WAC2d6-272A-03007 - - --- - -- YES NO RECORD DRAWING This is a pe manenr record and moat he accuse and seedier-ennuan<u,.Aoam m mo need or mvinlenanm..,ivdiea and future daveloym.q. Trcxal Record D an-gs corinn Din field d manroid oenahon a layoe:.sent naumotank location.Nonn +ow.reeare di arising and oroaosea dma 19S acauon o•sells.w . mnes e c e.eerra,on..,u...ea-cede a o"a,ma veiunce ac¢se mwmalex Rewm Ult may CreTe add l onal delays In fine l msralpuon asm—ul and n0i .to ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with I certify that the system has been installed in accor- the septic design Stamped'APPROVED"by Mason dance with the septic design stamped'APPROVED"by County Public Health and that any deviations shown Mason County Public Health and that any deviations here have been cleared/approved by both the designer shown here have been cleared/approved by both and Mason County Public Health and meet all State myself and Mason County Public Health and meet all and Mason County Codes. State and Mason County Codes I further certify that all information contained on this I further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Ding is accurate. Q� rZ1Zet� t Iclf�L� Si nature of Installer Date .--f Printed Name o/Signee " 1 J MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and r - Record Drawing on behalf of Mason County Public Health: iV X,�T�Mn► ^M^ b�t1�L� Sgna(ure of Environmental Heal(W Specialist Date (stamp, signature and date) THIS FORM MAY BE SCAN N EU AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uadaed ea s e ESMT N O D m �.J of O O . A n S _ O O3 9 F IAi A S N O A. O. 1. T J O D �... D N O N Q N N O C O O S O � � � O O m D D y n F 0 m y s O ESMT O n n Z " n°ii O O p O C N m oT � M y m Z fail 0 " o V� n T m it m � m o ➢ L D S p D N O A r A m m p D A O A